Social Worker at Westwood

Focused Post Acute Care Partners•Houston, TX

1d•Onsite

About The Position

Focused Care at Westwood is seeking a licensed Social Worker to connect residents with community resources and support their social and emotional needs, including those of their families when appropriate. The Social Worker interviews residents, coordinates and makes referrals, and applies knowledge of standard social work practices in long-term care. The role works closely with facility administration, medical and nursing staff, other departments, residents, responsible parties, and community agencies. The position is non-exempt and works an assigned schedule that may include weekends, evenings, and holidays.

Requirements

Bachelor’s degree in Social Work or a human services field, including Sociology, Gerontology, Special Education, Rehabilitation Counseling, or Psychology.
Must hold a Social Worker license in Texas or obtain one within six months of hire.
Able to respond appropriately to emergency situations.
Able to safely push, pull, lift, bend, kneel, and reach, including lifting up to 50 pounds, with or without reasonable accommodation.

Nice To Haves

Two years of experience in long-term care, a hospital, or another related medical facility is preferred.

Responsibilities

Meet with administration, medical and nursing staff, and other departments to plan social services.
Advocate for residents and help ensure their rights are maintained; report abuse, neglect, or exploitation according to state reporting guidelines.
Maintain professional working relationships with the interdisciplinary team and community resources and agencies.
Complete Social Service Histories and Social Service Evaluations for newly admitted residents within 14 days.
Complete MDS 3.0 sections B, C, D, E, and Q on required assessment dates and when there is a change of condition or readmission from hospitalization.
Educate residents about and assist with Advance Directives, Medical Power of Attorney, and Out of Hospital Do Not Resuscitate documents.
Coordinate ancillary service referrals, including obtaining physician orders, sharing information with service providers, and following up with residents and responsible parties.
Explain palliative care and hospice care and assist residents with referrals, transitions, and end-of-life decisions.
Obtain Medicaid prior authorization numbers for non-emergency ambulance transportation and assist with scheduling transportation to medical appointments.
Prepare Social Service Evaluations before care plans to assess changes and needs since the prior care plan.
Document assessments, assistance, interactions, and resolution of issues involving residents and responsible parties.
Coordinate discharge preparations and community services requested or required by residents and responsible parties.
Prepare care plans addressing advance directives, DNR orders, personal preferences, and behavioral or psychosocial issues.
Coordinate resident room changes, including required notices, follow-up, and documentation.
Review residents’ psychosocial well-being following the loss of a family member, friend, or roommate.
Attend Resident Council meetings when invited and assist with resolving issues raised.
Facilitate grievance procedures and help maintain the facility’s monthly grievance log.
Attend quarterly Performance Improvement / Quality Assurance meetings and provide information on referrals, behavioral issues, and grievance trends.
Conduct bi-annual reviews of resident charts to ensure assessments, documentation, directives, and care plans are current and consistent.
Maintain knowledge of applicable federal and state long-term care regulations and professional standards; recommend policy or procedure changes to the department director or Administrator.
Develop and maintain working relationships within the facility and with community health, welfare, and social agencies.